Precontemplation The person does not consider that there is a problem and does
not want to change. “My grand-father smoked all his life and he died at 96. So.
I don’t know if I really want to change my lifestyle habits Whether nutrition, stress management, physical activity, quitting smoking or taking a medication is the issue, you may not be ready to change any of these habits. This is completely normal. In fact, whether we realize it or not, when we start thinking about changing a behaviour, we usually go through different stages of change. A short description of these stages :
STAGES OF CHANGE Precontemplation
“My grand-father smoked all his life and he died at 96. So it must not be so bad for your health”
Contemplation
The person knows that there is a problem but is not ready to change
“I know that smoking is bad for my health, but I don’t feel ready to quit”
Preparation
The person has decided to make changes (within a month), is getting ready and making plans
“I plan on quitting smoking on June 18. From now on, I am getting ready to quit”
The person takes action and attempts to achieve his/her goal
“I quit smoking, but it is still difficult to resist temptation”
The person has maintained the changes for 6 months, but remains vulnerable
“I quit smoking 6 months ago and I remain vulnerable, but I feel less and less tempted”
The person loses motivation and goes back to old habits
“I thought that I would be able to smoke only one cigarette at Christmas, but I have started smoking again”
Maintenance
Relapse
• I tell myself: “I don’t feel like changing my eating habits (my diet)”. • I tell myself: “I don’t feel like doing any physical activity”. • I tell myself: “I don’t feel like quitting smoking”.
SMOKING AS AN EXAMPLE
The person does not consider that there is a problem and does not want to change
Action
If I am being given this document, it is because:
DESCRIPTION
Why include a description of the stages of change? • To make you realize that changing habits starts well before the action stage. We are already dedicated to improving our health when we plan to make a change. • So that you take time to pay attention to where you stand now with respect to the process of changing all the lifestyle habits that are detrimental to your cardiovascular health. • Using the above information, circle the stage where you stand for each of these health behaviours in the table below. NUTRITION
PHYSICAL ACTIVITY
STRESS MANAGEMENT
SMOKING
MEDICATION
Precontemplation
Precontemplation
Precontemplation
Precontemplation
Precontemplation
Contemplation
Contemplation
Contemplation
Contemplation
Contemplation
Preparation
Preparation
Preparation
Preparation
Preparation
Action
Action
Action
Action
Action
Maintenance
Maintenance
Maintenance
Maintenance
Maintenance
I don’t smoke
I don’t take any medication
I don’t know if I really want to change my lifestyle habits
Tool # 50
50 • So that you start thinking about the reasons why you are not ready to change. To start the thinking process, answer the following questions for each of the health behaviours listed:
I don’t know if I really want to change my lifestyle habits
1 Not at all
50
10 tremendously
Improve my diet
1
2
3
4
5
6
7
8
9
10
Improve my physical fitness
1
2
3
4
5
6
7
8
9
10
Improve my stress management
1
2
3
4
5
6
7
8
9
10
Quit smoking
1
2
3
4
5
6
7
8
9
10
Take my medication as prescribed
1
2
3
4
5
6
7
8
9
10
Do I really feel able to… 1 Not at all
10 tremendously
Improve my diet
1
2
3
4
5
6
7
8
9
10
Improve my physical fitness
1
2
3
4
5
6
7
8
9
10
Improve my stress management
1
2
3
4
5
6
7
8
9
10
Quit smoking
1
2
3
4
5
6
7
8
9
10
Take my medication as prescribed
1
2
3
4
5
6
7
8
9
10
To help you plan which behaviour you are going to tackle in the next few weeks, have a look at the following table. Your responses to the questions will indicate at which stage of the changing process you presently stand. You will find helpful suggestions, depending on the stage you identified. PRECONTEMPLATION
CONTEMPLATION
PREPARATION
ACTION
MAINTENANCE
RELAPSE
You have the right not to feel like changing your lifestyle habits. This decision is yours to make. We suggest you take a few moments to ask yourself: • What benefits do I get from maintaining the status quo? • What would be the benefits of changing this behaviour?
Make a list of the pros and cons of changing this behaviour.
Make a pledge, as a written contract for instance.
Make a list of the obstacles dampening your will to change.
Choose a realistic and attainable goal, and set a starting date.
Take one step at a time. Set yourself daily or weekly minor challenges.
Avoid feeling guilty and blaming yourself when you relapse. Instead, try to get back on course as soon as possible and stay the course (see tool #57).
First of all, tell yourself that it is normal to lose motivation occasionally. It happens to everyone.
If you feel like it, get information on the behaviour in question. For instance, look up the Internet site “Challenge Quit to Win!” to get more information on smoking and its impact. It does not hold you to anything!
Write the fears, concerns and worries associated with the change. If you feel comfortable, talk about it with your friends and loved ones.
You can also ask your friends and loved ones to talk about their concerns regarding this ongoing behaviour.
Make a list of what motivates you to change.
Don’t rush into the action phase. Take time to reflect and make an informed decision, knowing what you are really getting into (see tool #41).
Divide your final goal into smaller, realistic ones. Try to anticipate situations in which relapses can occur and plan how you will deal with them (I eat when I am bored in the evening, so I plan activities that I enjoy).
Talk about it with your friends, loved ones and colleagues and get them involved in the process (your walking partner for instance). Modify your environment to make life easier (leave your walking shoes by the door, don’t buy chips anymore or keep them out of sight). On a short term basis, avoid certain situations (avoid your smoking colleagues when you quit smoking). Use many different strategies: use reminders.
Feel the change a day at a time: “What can I do today for my health?” Don’t look only at the road ahead of you; look at the road you have already travelled. Take advantage of your social support to motivate you and continue rewarding yourself. Review your objectives on a regular basis to make sure they are still important to you.
When you go back to your old habits, you have two choices: 1) If you choose to see the relapse as a failure, it will certainly become a failure; 2) If you choose to see the relapse as an opportunity to learn something, it can help you to understand why it is happening, to look for ways to prevent similar situations from happening again and for ways to refocus and to forge ahead. The relapse will thus become a learning opportunity and it will help you to recommit to your goal.
Reward yourself when you have taken an important step forward. Make sure that the process will be as pleasant as possible.
I don’t know if I really want to change my lifestyle habits
How much do I really want to…
Now you realize that you are ready to change certain lifestyle habits, whereas you are not ready to change others. The important thing to realize is that there are some lifestyle habits about which you want to and can do something, and starting to take small steps today will improve your health. Identify one priority (diet, physical activity, stress management, quitting smoking, taking your medication as prescribed) that you want to change and that you feel you can change and answer the following questions in order to get ready. I want to begin changing: My 6-month objective is: In the next few weeks, I pledge to: This is what I plan on doing to help myself:
The main points • Identify where you stand for each of your lifestyle habits (diet, physical activity, stress management, quitting smoking, medication) • Determine your willingness to change and how able to change these lifestyle habits you feel you are • Now, identify one lifestyle habit which is a priority for you, that you want to and can change • Use the table above to help you start the process • Consider relapses as learning opportunities rather than failures
© Institut de recherches cliniques de Montréal Writing: Lysanne Goyer, PhD, Caroline Janelle, PhD (c), psychologists Graphic Design: Hélène Lambin, PhD Photography: JuhaT — fotolia.com
50
